Healthcare Provider Details

I. General information

NPI: 1992566673
Provider Name (Legal Business Name): NEUROPED EYE PR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 AVE JESUS T PINERO
SAN JUAN PR
00921-1722
US

IV. Provider business mailing address

1114 AVE JESUS T PINERO
SAN JUAN PR
00921-1722
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-3020
  • Fax:
Mailing address:
  • Phone: 787-781-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIAM S VILA DELGADO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-662-0200